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I am suffering from diabetes from last year but still not taking medicine, but walking and doing yoga. Is it ok? Or Should I go to the doctor for medicine.
Roti, rice and diabetes
Without controlling the sugar that goes through your mouth, trying to control the blood sugar with injections and tablets is utter nonsense. Throw away your roti and rice, sir!’ the bank manager was taken aback, did not expect this harsh comment from me. Here is the full story.
He was my distant relative, had come to invite me for a family function. He had been a diabetic for the past 15 years. Recently there was an increase in his blood urea and creatinine levels suggestive of ongoing damage to the kidneys. He requested me to suggest a good nephrologist for the same.
‘I am following my doctor’s advice religiously. Taking the drugs very regularly. I walk daily and am on a proper diet. Yet, why does this happen?’
‘is your sugar level under control?’
‘Hmmm. Reasonably. It is about 220 to 250 or so…’
‘That means, it is not under control’
‘The number of injections or tablets you take doesn’t count at all. If the blood sugar is not under control, you will have problems in your kidneys, eyes and even your nerves’.
That is what I am worried about. I don’t understand what’s happening. I just eat one or two rotis or idlis in the morning, some rice as lunch and one or two chappatis for supper. I avoid all fatty food’
‘Who told you that this is the right thing to do?’
‘You have to reduce the sugar in the diet. The amount of visible sugar used for tea or coffee is not that large. But most of the hidden sugar is in your staple food, rice or wheat, which are heavily loaded with sugars’’
‘What. Rice and wheat are bad for me?’
‘‘Undoubtedly. Without controlling the sugar that goes through your mouth, trying to control the sugar in your blood by injections and tablets is foolish. Abandon your rice and rotis, sir. Right now.’
‘But, my doctor said wheat is better for me…isn’t it true?’
‘Rice or wheat, sugar is the major ingredient, forming about 80-90%. Is your wife diabetic?’
‘Both of you are eating the same diet. Her sugar level is normal, because her body is metabolizing the sugar well. Your body does not know how to handle the sugar, hence blood sugar increases. It is as simple as that’
‘I am not sure if I understood well…….’
‘Suppose somebody is allergic to fish, what would you advice? avoid fish, isn't it. Or, would you advice him to take anti allergic drugs and eat fish? apply the same here. Your body is not able to handle the sugars. So, you have to give as less sugar as possible. Instead, you feed mainly on sugary foods and expect the body to behave well. Is it logical?’
‘Oh…getting your point doctor. So, what kind of food should I take?’
‘Take those which are rich in protein and fat’
‘What, you are advising me to take fat? are you serious?’
‘Ok. Just listen. When we say balanced diet, it should contain 50-60% carbohydrates, 15-20% protein and 15-20% fat. But the current diet pattern in the entire world, especially in india, has nearly 85% as carbohydrates. Because of the unjustifiable fear on the fat, we have replaced it with carbs. This is one of the most important reason for so many obese and diabetic patients in our country’
‘I don’t get you, doctor’
‘What happens when you eat roti or rice? they are converted to sugars. Body cannot save sugar as such. It has to be either used and burnt or it would be converted to fat and saved. Most of the bad cholesterol in the blood is derived from sugars. If a person is fat, its all derived from high sugar intake and not fat intake’
‘Oh. What should I do doctor?’
‘Simple. Reduce carbs and include fat so that it makes at least 30% of your calories. We can’t avoid carbs. I am going to ask you to eat lot of greens, vegetables, fruits, milk products, lentils, pulses etc. All of these have carbs. However, they are complex carbohydrates, will be absorbed more slowly into the body. Moreover you can’t eat them in large amounts as you do with rice and roti’
If we avoid rice and roti, what else to eat doctor, nothing!’
Take a full bowl of greens for lunch, a lot of cooked or uncooked vegetables and good quantity of curd’
Is it possible for anyone to follow this diet?’
Quiet. I am neither diabetic nor obese. Yet, I am following this eating pattern. If you have doubts, feel free to open my lunch box and check it out’
What about dinner?’
Today you take eggs. Only eggs, nothing else. It could be two or three. Tomorrow some panneer curry. Third day any other vegetable or a bowl of fruits. Do you want to eat fish or chicken? fine, take as much as you can, say 250-300g. But, you have to eat only that, no question of having roti/chappati or rice. You can plan any dish that suits you. To put it simply, whatever you have been eating as side-dish till now should become the main dish.
Will this satisfy our calory- needs?’
Yes, it will. And will also bring in lots of vitamins and minerals. Because you are forced to avoid rice and roti, you will eat good amount of greens, eggs, dhals, fruits and vegetables. The dishes which we discussed for dinner can be taken as lunch and vice versa’
What about break fast?’
You could take your coffee with a spoon of butter added to it. Take one or two eggs or some fruit or some nuts like badam. Or just take curd as much as you can. You can design yourself, there is no hard and fast rule. In case you are taking idli / dosa or roti, take as less as possible but with added ghee or butter’
You are telling everything just the opposite of what I do. I am really afraid….’
In that case, we can stop this discussion’
No…no…please go ahead. What about oils?’
‘most of the oils are good for the body, provided the foods prepared from the oil are taken fresh. Use the oil of the soil. We, tamilians should use gingely oil, our kerala friends should use coconut oil. These oils are safe for deep frying too. So, don’t worry in taking fried items whether it is vegetarian or non-vegetarian. Light oils like sunflower oil and other vegetable oils get denatured when heating. Hence avoid these oils. However, any oil in any fried item, if stored, is not good. So, things like chips, murukku and for that matter anything fried and crispy should be taken only once in a while. Many have the habit of storing that at home and taking regularly which is very dangerous’
But, will these be enough? what if I feel hungry?’
You can feel free to eat any amount of natural foods to fill up your stomach. All nuts, cucumber, carrots, plain coconut kernel etc can be taken anytime. These foods can be stored in multiple small boxes and should be readily available at home and at work place’
What about breads, biscuits and oats?’
Throw them away’
Hmm…let me see.’
He left appearing reasonably satisfied with my advice on diet. However, he returned within two days. This time, his wife had accompanied him.
Doctor, I told her everything. But she thinks I am lying.’
This is natural. For the past 50 years or so, we have ingrained so much of wrong information about the food that our mind will not easily accept if someone tries to challenge the long held beliefs. However, my task was easier with her as she had already listened from her husband. They met the nephrologist and got some advice for his kidney problems and left, only to come back 10 days later.
Sorry sir. I am finding it very difficult. It does not suit me. I get constipated at times and I don’t get good sleep ever since I changed my diet’
Don’t be anxious over the results. It’s too early. Remember you don’t have a choice in this matter. Follow the diet for another 10-15 days. You’ll get used to it.’
He shook his head and went away. He was not seen for the next five months. Accidentally, I met him at a marriage function.
Doctor, my sugar levels are less than 200 now. My doctor has increased the insulin dosage. He also prescribed a costly medicine which is working very well’
It did not take a genius to guess that he was not following the diet regimen.
‘sorry sir, I could not follow your advice. Your explanation was wonderful. But it does not suit me. I shared your advice with my doctor. He was shocked but that does not matter now. My blood-sugar is under control now. That alone matters.’
One of your medicines reduces the absorption of sugars. Another costly drug encourages the absorbed sugar to get excreted in the urine. Is there any logic in allowing you to take the sugars by mouth and then prevent its absorption at intestine and excrete it in the urine. You would be spending 20 rupees to eat and 200 rupees to get it out’
Even if you control your sugar level with injections and medicines, it does not reduce the chance of a heart attack or stroke’
Then what’s the big deal in reducing the sugar levels in blood?
Why don’t you ask your doctor?’
My point is that if you reduce your blood sugar by by life style modifications and natural means, you can prevent a heart attack or a stroke.’
He was silent for a while and then took leave. His was not a one-off case. No amount of counseling can make the people change their diet patterns.
Few months later, he visited me at my hospital. He appeared unhappy.
‘recently I got re-evaluated. Sugars are slightly up. Salt levels are also on the rise. I am really worried about my kidneys. I don’t know what to do’
‘i repeat what I said earlier. Please change your diet pattern at least now.’
This time he had no other go. He was now ready to make a drastic change in his diet. I put him on to our hospital’s dietician for further guidance.
I forgot about him. Four months later, I saw him in a mall. I wanted to avoid him. I vowed not to ask him about his health. I tried to move away. A few minutes later he came running to me.
‘how are you doctor?’
‘hmm…’ it was a bland smile and a bland response.
‘my wife saw you entering the mall. She insisted that I should see you. We have got an appointment with you this wednesday. You know something?’
I could see that the couple was happy.
‘Thank you very much doctor. I was forced to follow your advice. My sugar levels started coming down. In two months down the line I stopped insulin. My doctor was surprised. Yes, I did not tell him about my modified diet-plan as I was worried that he could potentially discourage me.
I was just happily listening him.
Doctor. You won’t believe this, doctor. Even the urea levels are coming down which I was told as irreversible earlier. I don’t know how to thank you. Looking forward to seeing you this wednesday with my latest lab reports.’
He folded his hands towards me and walked away. His wife stayed for a couple of seconds more, gave a thankful facial expression and left. That made my day. What else can make a physician happier than to see his patient getting healthier!